PROCEDURE_COST table

As of version 5.0.1 (5-Apr-2016), this table is no longer part of the OMOP CDM. It is replaced by the COST table.

For prior definition, see below.

The PROCEDURE_COST table captures the cost of a Procedure performed on a Person. The information about the cost is only derived from the amounts paid for the Procedure. This is in contrast to the Drug Cost data which also contain information about true amount charged by the distributor. In addition, Revenue codes are captured.

Field

Required

Type

Description

procedure_cost_id

Yes

integer

A unique identifier for each procedure cost record.

procedure_occurrence_id

Yes

integer

A foreign key identifier to the procedure record for which cost data are recorded.

currency_concept_id

No

integer

A concept representing the 3-letter code used to delineate international currencies, such as USD for US Dollar.

paid_copay

No

float

The amount paid by the Person as a fixed contribution to the expenses. Copay does not contribute to the out_of_pocket expenses.

paid_coinsurance

No

float

The amount paid by the Person as a joint assumption of risk. Typically, this is a percentage of the expenses defined by the health benefit Plan after the Person's deductible is exceeded.

paid_toward_deductible

No

float

The amount paid by the Person that is counted toward the deductible defined by the health benefit Plan.

paid_by_payer

No

float

The amount paid by the Payer. If there is more than one Payer, several PROCEDURE_COST records indicate that fact.

paid_by_coordination_benefits

No

float

The amount paid by a secondary Payer through the coordination of benefits.

total_out_of_pocket

No

float

The total amount paid by the Person as a share of the expenses

total_paid

No

float

The total amount paid for the expenses of the Procedure.

revenue_code_concept_id

No

integer

A foreign key referring to a Standard Concept ID in the Standardized Vocabularies for Revenue codes.

payer_plan_period_id

No

integer

A foreign key to the PAYER_PLAN_PERIOD table, where the details of the payer, plan and family are stored.

revenue_code_source_value

No

varchar(50)

The source code for the Revenue code as it appears in the source data, stored here for reference.

Conventions

Each Procedure Occurrence may have any number of corresponding records in the PROCEDURE_COST table, but often it is none (cost data not captured) or one (one payment per Procedure). They are linked directly through the Procedure Occurrence ID field.

If Procedures payments are bundled and the cost of such a bundle might be represented in only one of the component Procedures. The FACT_RELATIONSHIP table contains the relationship between the charged Procedure and the Procedure belonging to the bundle.

The amounts paid are:

Copay – a fixed amount to be paid by the Person

Coinsurance – a relative amount of the total paid by the Person

Deductible – an amount of money paid by the Person before the Payer starts contributing

Primary Payer – the amount the primary Payer pays towards the total

Coordination of Benefits – the amount a secondary Payer or Family Plan pays towards the total

Out of Pocket = Copay + Coinsurance + Deductible

Total – the total amount paid for the Procedure

The amounts in various payment components should equal the total, so Copay + Coinsurance + Deductible + Primary Payer + COB = Total Paid. In reality, this is not always reflected in the source data. It is up to the ETL to determine how to deal with quality problems in the data.

The revenue_code_concept_id determines what service within a provider is charging for the service